Billing code 45321: Volvulus decompressionMedicare rate & RVUs in Florida
Reports rigid proctosigmoidoscopy used to decompress a volvulus, typically during urgent treatment of sigmoid twisting and obstruction.
CMS doesn’t publish an office rate for 45321 in Florida.
Medicare allowed amount for participating (non-QP) physicians, before deductible, coinsurance and claim adjustments. Not a patient’s bill or a hospital charge.
On this page 9 sections
What 45321 covers
A clinician advances a rigid proctosigmoidoscope through the anus to reach the rectum and distal sigmoid, then relieves the distention caused by a volvulus. The service is generally performed by a gastroenterologist or colorectal surgeon in a hospital or other acute-care setting when endoscopic decompression is indicated. The code describes therapeutic decompression, not inspection alone; a flexible sigmoidoscope used for the same purpose belongs to a different code.
Select this code when the operative report supports use of a rigid scope and documents treatment of the volvulus by decompression. Record the indication, scope approach, and therapeutic work performed. CMS assigns a 0-day global period, so same-day preoperative and postoperative care is included. When related endoscopies are performed together, endoscopy family pricing applies. Modifier 50 is inappropriate for this service. Medicare does not pay an assistant at surgery, and co-surgeons and team surgery are not permitted.
This summary was written with AI assistance from CMS physician fee schedule data and checked against the CMS billing rules shown here. Rates on this page come directly from CMS files.
Where 45321 pays more and less in Florida
The same RVUs, adjusted for each area’s costs. Open a locality for its calculation, history and nearby areas.
| Payment locality | Office | Facility |
|---|---|---|
| Fort Lauderdale | Unavailable | $110.19 |
| Miami | Unavailable | $121.39 |
| Rest Of Florida | Unavailable | $104.10 |
How the 45321 rate is calculated
Each of 45321’s three RVUs is multiplied by a geographic index (GPCI) for the payment locality, added up, and multiplied by the conversion factor. Drag the indexes or enter a ZIP to see what moves the rate.
How the rate is built · 45321
RVUs × geographic indexes × conversion factor
Swap in your local Medicare rate.
Work 1.61Practice expense 0.90Malpractice 0.43
All indexes start at 1.000 (the national rate). Enter a ZIP or drag a slider.
Payment rules and modifiers for 45321
The CMS indicators that decide how 45321 is paid alongside other services.
CMS payment indicators · 45321
Volvulus decompression
| Rule | CMS value | What it means |
|---|---|---|
| Global period | 000 | Same-day global: pre- and post-op care on the day of the procedure is included. |
| Multiple procedures | 3 | Endoscopy family rules apply. |
| Bilateral (modifier 50) | 0 | The 150% bilateral adjustment doesn’t apply. |
| Assistant at surgery (80/81/82/AS) | 1 | Not paid (statutory restriction). |
| Co-surgeons (62) | 0 | Not permitted. |
| Team surgery (66) | 0 | Not permitted. |
| Professional/technical | 0 | Physician service: no professional/technical split. |
What modifiers do to the payment
Modifier 51 · payment effect
With and without the modifier
45321 without 51 · national facility
$98.20
Volvulus decompression
45321-51 · Second procedure: 50%
$49.10
When this isn’t the highest-valued procedure in the session, Medicare pays 50% of its fee schedule amount (the highest is paid at 100%).
45321 compared with similar codes
Compare codes
45321 vs 45337 vs 45300 vs 45330: national Medicare rates
Swap in your local Medicare rate.
How to choose
- 45337Sigmoidoscopy
- Both codes describe endoscopic decompression of volvulus. Choose based on the documented scope: rigid proctosigmoidoscope for 45321, flexible sigmoidoscope for 45337.
- 45300Proctosigmoidoscopy
- 45300 is diagnostic rigid proctosigmoidoscopy. Use 45321 when the rigid examination includes therapeutic decompression of a volvulus.
- 45330Flexible sigmoidoscopy
- 45330 describes diagnostic flexible sigmoidoscopy. It does not represent therapeutic decompression of volvulus with a rigid scope.
45321 billing questions
How does this differ from flexible sigmoidoscopic decompression?
This code is for decompression performed with a rigid proctosigmoidoscope. Use the flexible sigmoidoscopy code when the documented approach is flexible.
Can diagnostic proctosigmoidoscopy be reported separately?
When diagnostic inspection is part of the same endoscopic session as therapeutic decompression, apply the endoscopy family pricing rules for related procedures. The record should distinguish any separate service before considering separate reporting.
Is modifier 50 appropriate?
No. CMS identifies bilateral adjustment as inappropriate for this code.
What documentation supports code selection?
Document the volvulus, the use of a rigid proctosigmoidoscope, and the decompression performed. The documented approach helps distinguish this service from flexible sigmoidoscopic decompression.
Does the code include same-day care, and can an assistant be billed?
The 0-day global period includes same-day preoperative and postoperative care. Medicare does not pay an assistant at surgery for this service.
Where these rates come from
FeeBase calculates base physician payments from CMS work, practice-expense and malpractice RVUs, adjusted by each locality’s geographic indexes and the conversion factor. Services without a published rate are labeled, never given a made-up amount. Amounts are Medicare allowed amounts before claim adjustments: not a patient’s bill or a commercial rate.
CMS RVU26D · effective Oct 1, 2026 through the day before Jan 1, 2027
Show the CMS file lines behind this rate
Fee sheets
Put 45321 and the rest of your codes on one sheet
Build a fee sheet from your own code list at your locality, put your payer contracts beside Medicare, and see what changed each quarter.
Build my fee sheetOr price your code list free →